Floyd County supervisors propose increased ambulance service subsidy by Floyd County Medical Center

By Bob Steenson, bsteenson@charlescitypress.com

The Floyd County Board of Supervisors approved a proposal at a morning meeting Friday, July 26, asking the Floyd County Medical Center to agree to eventually pay one-third of the cost to subsidize ambulance services in the county.

It’s a suggestion that some members of the Medical Center Board of Trustees have opposed in the past, including arguing that the county needs its own ambulance service instead of subsidizing the private current provider, AMR.

The proposal also asks the Board of Trustees to set a meeting soon to discuss and take action on the proposal, because part of the plan relies on county voters passing an Emergency Medical Services (EMS) tax levy.

The wording of any such question for the Nov. 5 general election ballot needs to be approved by the supervisors and sent to the County Auditor’s Office by Aug. 28.

The proposal by Supervisor Chair Mark Kuhn was a continuation of sorts of a discussion that had ended with an abrupt adjournment at an FCMC Board of Trustees special meeting last Tuesday, July 16, after trustees thought Kuhn had accused them of holding a “secret meeting” in potential violation of the Iowa Open Meetings Law.

On Friday morning, during a usually routine part of supervisors meetings where board members update each other about the meetings they have attended on the many boards and commissions on which they represent the county, Kuhn began a lengthy description of what had happened at the Medical Center Board of Trustees meeting on July 16.

Kuhn said he had not intended to imply that the trustees had held a secret meeting, and he had been referring to a different group.

But then he went on to say that he thinks the trustees have been violating the Iowa Open Meetings Law by discussing topics during their meetings that have not been listed on the agenda, or else have been discussing them under catch-all topics such as “old business” that are not allowed under the Iowa law.

Dawnett Willis, CEO of the Medical Center who was at the supervisors meeting, said forcefully, “We have not violated any meeting rules. Period.”

Kuhn said, “Well, I think you should review the meetings law because currently your minutes of several meetings reflect the discussion about really pertinent issues regarding the EMS trust fund, what we’re going to do to provide it,” but the discussions aren’t listed on the agenda.

After Kuhn’s synopsis of the July 16 trustees meeting and his accusations of Iowa Open Meetings Law violations had gone on for more than 22 minutes, Sharon Enabnit, a hospital trustee who was at the supervisors meeting, said Kuhn’s lengthy discussion had not been listed on the supervisors agenda as anything more specific than “Updates on various boards/commissions/activities since the last meeting.”

Kuhn said it was part of the meeting where the supervisors update each other.

Willis said, “So the rules apply differently to everybody else?”

A few minutes later, as the discussion of the previous meeting continued, County Auditor Gloria Carr, who takes minutes at supervisors meetings, said, “I think you’ve gotten off of topic of this agenda item and I don’t think …”

Kuhn cut her off, saying, “We’re just taking comments and it’s two minutes before we open up the discussion about the ambulance.”

Later, under the agenda item for review and action on an updated proposal to maintain ambulance services, Kuhn presented his plan asking the Medical Center to commit to contributing an increasing amount of money to help subsidize ambulance survive provided by AMR if a new three-year contact with AMR is signed beginning July 1, 2026.

Currently, the Medical Center has agreed to pay more than $100,000 per year under the existing AMR three-year contract.

The trustees initially offered to contribute $100,000 last year, after the AMR subsidy in the contract that ended June 30, 2023, increased from $200,000 to $415,000 and Charles City and Floyd County – which were splitting the cost of the subsidy – said they didn’t know how they would pay more than double what they had previously.

In April this year, as the first year of the current AMR three-year contract was nearing its end, the Medical Center trustees signed an agreement with the city and county to contribute $103,000 in the second (current) year of the AMR contract, and $106,090 in the third year.

Those figures represent a 3% increase each year, the same amount that the total subsidy is increasing.

Kuhn’s proposal presented Friday is to ask county voters to approve an EMS property tax levy of $450,000 per year for five years to go into an EMS Trust Fund. The money could only be used for EMS purposes as defined under Iowa Code.

If the voters approve the levy and AMR agrees to another three-year contract beginning July 1, 2026, the EMS Trust Fund would be used to pay for the AMR subsidy.

Kuhn’s proposal is to amend the agreement among the county, city and Medical Center to increase the Medical Center’s contribution to:

• $119,645.94 in the first year of a new AMR contract from July 1, 2026, to June 30, 2027.
• $133,202.88 in the second year, running from July 1, 2027, to June 30, 2028.
• And $146,757.82 in the third year of a new AMR contract, from July 1, 2028, to June 30, 2029.

That figure of $146,757.82 represents one-third of the cost of the third year of the AMR subsidy under the current contract, which is $440,274. It does not account for any jump in the subsidy cost for a new AMR contract, or for annual cost increases such as were included in the previous AMR three-year contract or the current three-year contract.

Under Kuhn’s proposal, the county and Charles City would no longer directly pay toward the subsidy, with the remaining two-thirds of the cost coming from the EMS Trust Fund.

Medical Center trustees, including Trustee Chair Ron James, have previously dismissed this idea, arguing that the Medical Center would be asked to increase its contribution while the county’s and the city’s cost goes to zero.

Kuhn has said that whether the city and the county’s payments come from their general funds or that amount comes from the EMS levy, it’s property taxes either way.

Supervisor Dennis Keifer said he thinks the Medical Center should pay one-third of the costs to subsidize ambulance service because it benefits directly from that service.

Supervisor Jim Jorgensen said, “It’s simply a proposal, in my mind. I’m never afraid to ask, and that’s what we’re doing. They discuss it. They choose to approve it, decline it, and from that point we go forward.”

Jorgensen said, “I think we need to keep the conversation open to an in-house ambulance service in the future. I do feel that we don’t know where the next increase is going to land from AMR. So, can we do it cheaper than AMR? That’s pretty much an unknown until you get your feet in the water.”

The supervisors voted unanimously to pass Kuhn’s proposal.

As of the posting of this article a special meeting of the Medical Center Board of Trustees had not been scheduled. The trustees typically hold meetings on the third Monday of the month. The next regularly scheduled meeting would be Aug. 19.