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Upper NW rescue deal draws critics

(Published January 27, 2003)

 

By JOHN DeVAULT

Staff Writer

Susan Payne was upset when her mother broke her hip and emergency medics refused to take her to the hospital where her longtime doctors were based. They told Payne they were required to take all patients to the nearest hospital.

If Payne had lived over the District-Maryland border in Washington’s affluent Ward 3, her mother could have gotten free transport to the hospital of her choice from another part of the same Montgomery County Fire and Rescue Service that refused her request.

“We had to pay for a private ambulance to take her to Suburban [Hospital],” said Payne, founder of a northern Montgomery County citizens group called the Upcounty Community Coalition.

Payne and others in Montgomery County, which is facing budgetary restraints, are beginning to raise questions about an unusual cross-jurisdictional deal that already has been criticized in parts of the District.

“This is a service being extended to D.C. residents that’s not being extended to [Montgomery] County residents,” complained Payne.

Under a May 2001 agreement between the District’s Fire and Emergency Medical Services Department and the largely volunteer, “public-private” Bethesda-Chevy Chase Rescue Squad, Ward 3 residents may dial a 301-area code number – instead of 911 – and choose to be transported to a hospital by a Maryland-based ambulance.

Sometimes, a call to 911 from Ward 3 results in a Bethesda-Chevy Chase (B-CC) ambulance being dispatched to the scene – in addition to a D.C. ambulance.

Under the service agreement, which sends B-CC ambulances into the District several times a day, or at least 1,500 times a year, Ward 3 residents also can designate which hospital they want to go to, whether in the District or Maryland. According to B-CC Chief Ned Sherburne, many Ward 3 residents choose Suburban, Holy Cross or another suburban Maryland hospital.

That kind of choice is not available to either D.C. residents in the city’s seven other wards or to Montgomery County residents outside of Bethesda-Chevy Chase’s service area, all of whom dial 911 and are taken to the closest appropriate facility, as protocols in both jurisdictions dictate.

“We discourage Maryland residents calling our 301 number,” Chief Sherburne said. “Please, don’t put it in your paper that Maryland residents can call the 301 number.”

The service is free. Bethesda-Chevy Chase supports its operations by an annual fund drive in both Ward 3 and Maryland.

District residents outside of Ward 3 are billed about $250 to $400 when they use D.C. ambulance service, according to the D.C. government’s web site.

Payne, a political ally of Montgomery County Executive Douglas Duncan, said she recently brought up to Duncan the issue of what she sees as the unfairness of the arrangement.

“These are the D.C. people who are most able to pay for their own service,” she said.

She noted that due to big Maryland state budget deficits, Montgomery County’s own emergency services face cuts this year.

“If we have a force that could cover a part of the area here, that could save the county a lot of money,” she said. “They could be deployed elsewhere in Montgomery County where they’re needed, like to Takoma Park or Wheaton.”

The Montgomery County Fire and Rescue Service faces a 1.5 percent budget cut this year, department spokesman Peter Piringer said. “And there will probably be more to come,” he added.

In the District, critics have charged that the deal shows a lack of commitment to the city by some of its most well-off and politically influential residents – especially at a time when D.C. Emergency Medical Services chief Stephen Reid has said that under-funding of D.C. emergency services and resulting personnel and equipment deficits have produced an EMS “crisis.”

“When a significant part of the city with significant political clout is getting their care outside the city’s services, there will not be the pressure brought to get this agency the resources it needs to do its job,” said Kenneth Lyons, head of the local union that represents the District’s EMS workers.

“While some have, others will not have,” he said.

Lyons said that the part of the city most in need of a special deal to beef up ambulance service is its eastern half, owing to the impact of recent deep cutbacks in emergency room access at financially struggling Greater Southeast Community Hospital in Ward 8, and the related decision earlier this month to shut down all ambulance access to the former D.C. General Hospital facility in Ward 6.

Lyons, an active D.C. paramedic, said the agreement also unnecessarily ties up D.C. emergency vehicles. Often, he said, ambulances from both Maryland and the District respond to Ward 3 calls.

Normally, officials in the District and Montgomery County said, when a Ward 3 resident calls either (301) 652-1000 or 911, the dispatcher in the jurisdiction that was phoned alerts his counterpart. Then the D.C. dispatcher, in keeping with citywide protocols, sends a D.C. fire truck, which carries emergency medical technicians, to the scene as a “first responder.”

“Nine times out of 10, that unit gets there (before Bethesda-Chevy-Chase),” D.C. Fire and EMS spokesman Alan Etter said.

After conferring, the D.C. and Maryland dispatchers each also usually send an ambulance or other EMS vehicle to the scene – often a “basic life support” unit from one jurisdiction and an “advanced life support” unit from the other – for a variety of reasons, officials said.

Sometimes, Chief Sherburne said, the level of care needed isn’t clear, so vehicles with different capacities are sent.

Another reason for ambulance piggy-backing appears to be that because Montgomery County medics don’t meet all of the District’s training protocols, they can’t administer medications in D.C. So if a Ward 3 resident needs medications at the scene and wants transport to the hospital of his or her choice – or just wants to ride for free – a D.C. paramedic must administer the medications before the patient is carried to the hospital in a B-CC ambulance.  

Indeed, Chief Sherburne said that when the caller has dialed the 301 number and hospitalization seems possible, he usually sends a transport unit because people dialing that number expect free service and a choice of hospitals.

“But medical concerns come first,” he said.

And he said he usually sends an ambulance even if D.C. has reported dispatching one because “sometimes – it’s rare – a D.C. person calls 911 and nobody answers or shows up.”

The result is that, in most cases, three vehicles answer calls in Ward 3, whereas only two – the first responder engine and an EMS vehicle – come to calls elsewhere in the city.

“Whenever a call to Bethesda-Chevy Chase comes in, there goes the ALS (advanced life support) unit stationed in Northwest or Northeast,” Lyons said.

“That might be a fair question to ask,” said Etter when asked if the doubling-up represents a good use of D.C. resources.

The territory served in the deal conforms to the boundaries of Ward 3: from the Montgomery County border in the west to include the Palisades, Cathedral Heights and Cleveland Park neighborhoods in the south, extending east to Rock Creek Park, and north through Tenleytown, Friendship Heights and Chevy Chase.

Etter said he doesn’t know why the service area was limited to Ward 3.

James B. Martin, the D.C. fire department’s acting assistant chief for operations, echoed Chief Sherburne, suggesting that the deal’s boundaries relate to the B-CC squad’s ability to keep up acceptable response times. But Martin said he knows of no studies by the department to establish that fact.

Advisory Neighborhood Commission 3/4G Commissioner Anne Renshaw, who represents the District’s Chevy Chase neighborhood, defends the city’s pact with Bethesda-Chevy Chase.

“We need the service of Bethesda-Chevy Chase,” she said. “We have so few transports in Upper Northwest…and the population is increasing, with the building boom in Friendship Heights.”

She noted that various versions of the service have been in place for decades, dating to a time before the District had its own professional EMS department.

She said that the 1995 termination of a rescue squad based in Friendship Heights, along with the recent transfer of an ambulance out of Tenleytown during renovation of a fire station there, necessitates Ward 3 getting service from outside the District.

She dismissed the city’s justification for the closing of Rescue Squad 4 during a 1995 budget crunch – because it was one of the city’s less-used emergency units – saying Ward 3 residents have a right to prompt emergency response when the need arises.

“We think that the fire department should be like the Maytag repairman,” she said. “We would prefer that they sit and have nothing to do.”

“We’re just thinking of getting care to that patient,” she said.

Ward 3 Councilwoman Kathy Patterson, whose office pushed hard for the agreement, according to Chief Sherburne, also defended the deal.

“If for some reason that service was to end, I’d have to go looking for dollars here in D.C. to replace it,” Patterson said. “And in our current budget atmosphere, they wouldn’t be easy to find.”

Lyons criticized Patterson’s role in inking the agreement. He cited her position as head of the council’s Judiciary Committee, which oversees the city’s emergency services.

“Her job [as committee chairman] is to serve all of the people, not a few in the city,” he said. “What disturbs me is that she allowed her role with her constituents to overwhelm somewhat her role as head of the Judiciary Committee, which is to serve all of the residents in the city.”

Patterson rejected the accusation, saying, “In the two years I’ve chaired the committee, we’ve worked hard to get fire and EMS the resources they need. We’re working on ‘hiring-up’ in EMS. Pay is not competitive. We’re pressuring the Williams administration to raise salaries and benefits.”

She added, “There are things you can do by oversight, and things you can’t.”

In Montgomery County, Takoma Park Councilman Mark Elrich questions the wisdom of the deal.

“It strikes me as inappropriate,” he said. “I’d hate to think there’s something available for D.C. folks that’s not available for Montgomery County residents, especially if it’s something that could be provided in D.C.”

He echoed Payne in suggesting that Bethesda-Chevy Chase’s resources might be better allocated within Montgomery County.

Chief Sherburne noted that some county residents have pushed to move some of the county’s fire and rescue squads located near its borders with Prince George’s County further inside the county, to make them less attractive to Prince George’s County dispatchers when that county’s emergency units get over-burdened.

But Chief Sherburne, along with other county officials, defended Bethesda-Chevy Chase’s runs into the District as appropriate, because the squad is primarily volunteers and gets most of its $1.2 million operating budget from an annual fund-raising drive conducted on both sides of the D.C.-Montgomery County border.

He said B-CC does not receive Montgomery County tax dollars, so it is free to provide service to whomever it pleases.

But county officials readily acknowledged that Bethesda-Chevy Chase is part of Montgomery County’s fire and rescue system, which is a combined volunteer and paid-staff operation.

“Bethesda-Chevy Chase is one of our organizations,” Montgomery County Fire Chief Roger Strock said. “They’re an integral part of our system.”

The squad’s listing in the current Verizon Montgomery County telephone directory is in the blue governmental pages, under the “Montgomery County” heading.

And, Chief Sherburne acknowledged, his company does receive some substantial county resources. All B-CC volunteer personnel receive training at the county’s academy in Darnstown, Md.

And not all Bethesda-Chevy Chase staff are volunteer. The county details two paid paramedics to the station every weekday from 9 a.m. to 5 p.m. to man one of the three or four ambulances typically on call.

“The value of them is high in terms of our operations,” Sherburne said.

Bethesda-Chevy Chase is part of the county’s emergency dispatch system, and the county equips all of its vehicles with radios. [B-CC has also received more than $50,000 worth of two-way radios from the D.C. government, so its fleet can coordinate runs into ward 3 with the District’s EMS operations.]

And while Montgomery County does not give any locally collected tax dollars to Bethesda-Chevy Chase, the county does help fund the squad by giving it a share of state and federal funds the county receives.

For example, the county gives the squad a $60,000 annual share of state funds for volunteer fire forces. Last year, the county gave B-CC a $300,000 share of a federal grant it received related to post-Sept. 11 emergency preparedness.

Sherburne, who said he grew up in Woodley Park in the District, cited Bethesda-Chevy Chase’s longtime provision of service to nearby D.C. neighborhoods as a reason to continue the service.

“Our roots there go deep,” he said.

However, money is an issue, too.

Citing the $213,000 raised in the District of the $982,000 total brought in during the squad’s most recent fund drive, Sherburne said there is “a financial impetus” for B-CC to stay with the deal.

“It would be hard for us to drop our service to the District without substantially changing our funding base,” he said. “At times my gut reaction is, ‘Let’s not do that anymore,’ but then that funding goes away.”

Bethesda attorney and tax activist Robin Ficker, a critic of the deal, said the service brings up “a truth in labeling problem.”

“They call it the Bethesda-Chevy Chase Rescue Squad, not the Bethesda-Chevy Chase-D.C. Rescue Squad,” he said.

Ficker said he has received many fund-raising letters from the squad over the years, but never noticed any mention of its D.C. services.

“I don’t think it’s generally known this is happening,” he said. 

But in Ward 3, resident Ed T. Barron applauds the deal. He said he contributes $50 to the Bethesda-Chevy Chase fund drive every year.

“They’ll take you to the hospital you select. If D.C. comes and picks you up, they take you wherever the heck they want,” he said. “And Chevy Chase does not charge.”

“This lets D.C. concentrate on other wards in the city,” he said.

 

Copyright 2003, The Common Denominator