Floyd County emergency medical service groups recommend voters be asked to approve five-year $450,000 or $490,000 annual EMS levy

EDITOR’S NOTE: This story originally published with an incorrect time for a Floyd County Medical Center Board of Trustees special meeting called for Tuesday, July 23. That meeting will be at 7:45 a.m. in the Veterans Room at the Medical Center.

By Bob Steenson, bsteenson@charlescitypress.com

Members of the Floyd County Ambulance Commission spent a long and sometimes heated meeting Tuesday evening making a dramatic change of course from a decision the group had made earlier in the year.

The commission, with representatives of Floyd County, Charles City and the Floyd County Medical Center, is tasked with making recommendations on how the county can provide ambulance and other emergency medical services (EMS).

At the end of the meeting the group agreed to make a recommendation to let county residents vote on a $450,000 annual EMS levy to be collected through property taxes and to be in effect for five years. The money could be used solely to support EMS in the county.

A meeting of another group, the Floyd County EMS Advisory Council, which is the next step in the recommendation progress, met after the Ambulance Commission meeting Tuesday evening and recommended a $490,000 EMS levy, for five years.

The $450,000 recommendation had passed unanimously by the six members of the Ambulance Commission present, but only after a great deal of discussion regarding the terms, and with the knowledge that the commission doesn’t have the last – or even the second to the last – word on what county residents could actually be voting on.

At the commission’s previous meeting held more than four months ago in March, the members had agreed to recommend a markedly different proposal – a 15-year countywide property tax at an amount that could raise up to about $776,000 annually.

Keith Starr, the City Council representative on the commission and its chair, had pushed strongly for that proposal then, with the idea that the money – likely along with loans as well – would be used to start a public ambulance service to serve the entire county.

The levy figure was an “up to” amount, and the commission members at that time thought less than the full amount would be necessary after a new public ambulance service was up and operating.

At the meeting Tuesday evening, Starr said he and others had realized that the proposal was not supported by the Floyd County Board of Supervisors, which has the final say on what, if anything, regarding an EMS levy would be placed on the ballot for the Nov. 5 general election.

Starr asked newly appointed Ambulance Commission member and county Supervisor Mark Kuhn to present Kuhn’s proposal that the supervisors had discussed at their meeting last week.

Kuhn’s proposal was to ask voters to approve an EMS levy of $400,000 in countrywide property taxes for five years, plus continued contributions from the Floyd County Medical Center.

That money would be placed in a county EMS Trust Fund that would be established as provided for in Iowa Code, to be administered by the Board of Supervisors and used to pay the subsidy for the current ambulance provider, American Medical Response (AMR).

Much of the meeting Tuesday evening dealt with the direction for future ambulance service in the county and the Floyd County Medical Center’s involvement in funding that service.

Commission member Dawnett Willis, CEO of the Medical Center, said that when the hospital Board of Trustees agreed in April to continue contributing toward the cost of ambulance service in the final two years of the current three-year AMR contract, it was with the understanding that there would be planning for what could replace AMR.

“I don’t think that staying with AMR is a stable solution. The cost is not sustainable,” Willis said.

She said she had no complaints with the service provided by the local AMR crew, but she has no trust in AMR’s parent company, which decides what the subsidy level will be in each new contract and has declined to provide comprehensive financial information about the company’s business in Charles City.

Funding has become an issue because the cost to subsidize AMR service in the county has increased dramatically, from AMR originally years ago paying the city annual fees for services and ambulance housing the city provided, to a $150,000 subsidy to AMR in the first year of a previous three-year contract that began July 1, 2020, to $415,000 in the first year of a new three-year contract that began July 1, 2023.

That new contract, now in its second year, is currently costing $427,450, and that figure will go to $440,274 in the final year of the contract from July 1, 2025, to June 30, 2026.

The subsidy has been split equally between Charles City and Floyd County, except that the Floyd County Medical Center Board of Trustees agreed in April 2023 to contribute $100,000 toward the subsidy in the first year of the new three-year contract after the AMR subsidy cost more than doubled.

In April this year, the Medical Center Board of Trustees approved a 28E agreement with the city and county, with the Medical Center agreeing to reimburse them $103,000 in the second (current) year of the AMR contract and $106,090 in the third year (equaling the 3% per year increase the city and county are also paying).

Supervisor Kuhn’s proposal presented to the Ambulance Commission Tuesday evening was for a $400,000 annual EMS levy for five years, with the Medical Center continuing to contribute the amount it had agreed to annually, and the three entities – county, city and hospital – splitting any additional cost if future AMR subsidies were not covered by the levy and the Medical Center contribution.

Kuhn said he didn’t think there was any way that county voters would approve the 15-year $776,000 proposal by the 60% majority required, calling it “for too much, for too long,” and he said would not support putting that question on a ballot.

Kuhn said he had talked with AMR representatives and they were willing to talk about an additional three-year contract, but they would not discuss the future subsidy amount.

He said he didn’t think it would increase as dramatically as the increase between the previous three-year contracts, but commission member Sam Deverell, the new Charles City fire chief, said he doubted anyone had expected the current contract to increase as much as it did.

Police Chief Hugh Anderson, an Ambulance Commission member, also advocated for coming up with a solution to get away from relying on AMR.

Referring to AMR’s parent company, Global Medical Response, Anderson said, “We’re looking at the largest EMS provider in the world. They don’t care if we’re struggling to pay this. They think the city, county and hospital are an endless supply of money.

“It would not surprise me if they came back with five, six hundred thousand dollars” in the next contract proposal, Anderson said.

Willis said that’s why the Ambulance Commission had looked at starting a public service.

She said any decision on a continuing Medical Center contribution would ultimately be up to the Board of Trustees, but as the chief executive officer she would have a hard time recommending entering an agreement where the future cost is unknown, especially in light of the $50 million hospital and clinic expansion project the Medical Center is just starting and the fiscal requirements involved in that.

The Medical Center Board of Trustees has called a special meeting for Tuesday, July 23, at 7:45 a.m. to address Kuhn’s request for “discussion regarding BOS (Board of Supervisors) plan for EMS funding.”

In the end, the Ambulance Commission agreed to a proposal to ask voters to vote on a $450,000 annual EMS levy to last five years. They raised the annual dollar amount because members did not think the $400,000 Kuhn proposed would be sufficient.

That recommendation went to another recommending body, the Floyd County EMS Advisory Council, which met after the Ambulance Commission meeting and agreed to a recommendation asking for $490,000 annually for five years, agreeing that amount more accurately reflected actual costs to subsidize AMR service and other EMS services in the county.

As part of a process where counties can declare EMS an “essential service” and ask voters to approve a tax levy to support it, an advisory council was created to do research and make a recommendation to the supervisors for a ballot question.

A previous attempt to create an essential services levy failed in the 2022 election, when Floyd County voters fell far short of the 60% supermajority required to approve the levy.

The current EMS Advisory Council – which includes Starr and Willis as members – had previously agreed unanimously with the 15-year, $776,000 annual EMS Levy proposal, but it had not made a formal recommendation to the supervisors.

Several people at the meeting Wednesday noted that time is running short to do something this year. Kuhn said that the language for a ballot question must be decided and approved by the Board of Supervisors by Aug. 28 in able to get it on the Nov. 5 ballots for Floyd County.