The financial situation and operating model of Madison’s ambulance service took center stage at a recent budget workshop, as town officials held off on the service’s request for a significant budget increase in the while promising to commission a study that will potentially result in a total rethinking of its operating model.

Madison Ambulance Association President Sam DeBurra and Director Chris Bernier presented a budget with a $253,000 increase over last year to a joint meeting of the Board of Selectmen (BOS) and Board of Finance (BOF). Much of that increase is due to offering staffers health care benefits for their family members, DeBurra said.

The non-profit association is not technically a town department, and is partly funded by donations, partly from billable services, and partly by the town. The town covers about 25 percent of the association’s approximately $1.5 total budget each year.

Controversy has arisen in recent years as association representatives have consistently had to ask for special appropriations to cover their operating costs, most recently receiving $110,000 in 2019. The association also had to draw an additional $55,000 from its reserves.

The issues with the current operating model have been well documented and discussed several times in recent years without much changing. State law prevents the association from billing patients if they are not transported to a hospital, and patients using Medicare or Medicaid—a significant portion of Madison’s population—can only be billed at a rate much lower than state guidelines.

This means the association has to write off a large amount of its billable services—more than $700,000 in 2018, Bernier told The Source last year.

Early last year, the BOF asked the BOS to commission a study that would give the town an idea of how it might consistently fund the association. That study never took place.

Now, with a new administration and several new members on both the BOS and BOF, the town is again promising to put together a study that will guide the town on how to make the association’s business model workable without these yearly cash crises.

“Because of things that are outside of your control, it is not something that can be sustained,” said BOF Chair Jean Fitzgerald. “The town has to make a decision [on] how much we want—what is our priority—of whether we want an internal ambulance...It seems to me that over the years, we have all agreed that is a priority.”

Until then, however, Fitzgerald told The Source in an email that she believes both she and Lyons “would feel more comfortable waiting [un]til we get the study done before we make any significant changes to their operational budget.”

Finding “consistency and predictability” in the budget was another consideration when considering the ambulance operating model.

According to DeBurra and Bernier, that $253,000 increase is not only to avoid coming back for more special appropriations later in the year, but also an attempt to hold on to employees. DeBurra told town officials that the association has failed to fill an open paramedic position for more than 18 months, as it cannot offer competitive salaries or benefits. Bernier said the association has lost “five, six employees” over the last year to other departments, including Guilford, for the same reason.

Another part of the $253,000 that the association is asking for is due to setting new pay scales in order to retain and recruit employees, Bernier said.

Both Fitzgerald and First Selectman Peggy Lyons assured Bernier and DeBurra at the meeting that the study would help the town make Madison’s ambulance not only sustainable, but solve these staffing issues.

“The reality is, these boards have not followed up on our obligation to get the proper model,” Lyons said. “So we’re making the commitment again—but I’m also new to the board, and I’m making the commitment that that will happen this year.”

DeBurra wondered, though, whether the amount of time the study would take might end up leaving the association still struggling for an inordinate amount of time, possibly even through next budget cycle.

“By the time you get the [request for proposals] out and the company selected, it’s probably going to a year and a half before you get the study done,” DeBurra said.

Fitzgerland and Lyons said that the town would be willing to provide whatever funding was needed between now and when the study is completed. Fitzgerald reiterated this position in response to an email to The Source.

“It is my belief that if during the study period the ambulance falls short of its financial responsibilities the town would help them,” she said.

Lyons has spoken about a more comprehensive study of all of the town’s emergency services, which potentially would include information needed to revamp the association’s operations. Fitzgerald proposed expediting a study of the ambulance association to avoid the delay.

Lyons told The Source that it was possible that both studies would happen in conjunction with this broader study while making sure the town was able to address issues with the ambulance in a timely manner.

“If there’s a way to still keep it under the umbrella of the broader study, but maybe step one is to look at the ambulance service, then that would be ideal, obviously,” she said.

Because the ambulance shares issues and functions with other emergency services, Lyons said it was likely that incorporating all of them together would be beneficial for everyone, including the ambulance.