The great ambulance debate in West and South St. Paul

It was a relatively slow Tuesday afternoon at the South Metro Fire Department (SMFD) station in West St. Paul when a call came in about a 2-year-old having a seizure.

At 2:49 p.m., one of the department's three ambulances was dispatched.

By 2:52 p.m., the firefighters arrived at the West St. Paul home, where they checked the girl's vitals, fitted her with an oxygen mask and heard about her medical history. More than five minutes after the firefighters reached the scene, another ambulance, this one operated by HealthEast Medical Transportation, arrived to assess the situation and provide further care.

By 3:06 p.m., South Metro had cleared the scene. The girl was placed in HealthEast's ambulance, which had medications available to help treat her if she had another seizure en route to the hospital.

It was a glimpse at the way many medical emergencies have been handled in South St. Paul and West St. Paul for years, with the joint city Fire Department and HealthEast, which has the state-issued license to serve the two cities and several other southern suburbs, both responding.

The arrangement could be in jeopardy because HealthEast, during contract negotiations with SMFD, is insisting on changes that would cost the department money and, most likely, result in staff cuts. Those cuts -- or other changes, such as the fire department turning all the ambulance calls over to HealthEast -- could increase response times, critics say.

"When you're having an emergency medical situation and someone gets there in four minutes and someone gets there in ten minutes ... People can live or die in those six minutes," said Chris Lehmann, SMFD board member and South St. Paul city councilman. "And I'll tell ya, the patient or citizen sitting there isn't worried that 'Oh my goodness, another ambulance is roaring down my street.'"

SMFD's board of directors will meet on Wednesday to weigh options and hear recommendations from the fire department's chief.

Under the current arrangement, South Metro acts as a first responder, with crews providing immediate care and possible transportation to the hospital. HealthEast coordinates who transports the patient and handles the most serious cases.

As it stands now, the SMFD collects about $650 for each ambulance transport it makes, generating about $330,000 a year. However, in negotiations that have to be settled before the end of the year, HealthEast is insisting that it take over billing for ambulance services and reimburse the Fire Department at about $240 a trip. The new arrangement could mean a $152,000 drop in revenue for the department next year.

HealthEast also has suggested that it could provide all ambulance service, including for the less-serious cases.

If the board doesn't like either of these ideas, South Metro could take over ambulance transports entirely from HealthEast, but that would mean spending time and money to revamp the department.

HealthEast has argued that the arrangement it's requesting -- which besides the billing changes, would also include additional department training, purchase of about $30,000 worth of road safety equipment and the creation of a computer interface that is compatible with HealthEast's -- are intended to make operations more efficient.

HealthEast said that the $240 per-transport fee it's proposing is what it would spend to provide the same service. Allison Sandve, a HealthEast spokesperson, said HealthEast charges less for those kind of transports than what the Fire Department does and HealthEast could provide better service because its ambulances are staffed with paramedics.

But fire chief John Ehret disputes some of that. According to a recent study, SMFD charges less than average for the transports it does, he said. Also, SMFD doesn't charge if its responders just treat a patient without a hospital trip, but HealthEast does, he said.

Englin said that if revenues are cut, service quality could go down because of staff reductions.

"I think anytime you start chopping off personnel you start compromising resident safety," he said.

Considering next year's budget, Erickson said there is little that could be done to find sustainable savings outside of letting people go.

"Even if it's the [$152,000 number], we are at least looking at one position that we would need to eliminate," he said.

As the firefighters waited for emergency calls last week, Mark Anderson, who has been in the department for 17 years, talked about his own misgivings waiting for the contract negotiations to be done.

"Anytime you hear that there's going to be people walking out the door, you get kinda nervous," he said.

Nicole Norfleet • 612-673-4495