GATESVILLE – A possible scenario to help Gates County Rescue & EMS fund a second full-time ambulance and crew (24/7/365) involves the implementation of a tax service district countywide.

But that plan cannot move forward without first gauging the opinion of the county’s tax-paying citizens.

Following a lengthy discussion at their regularly scheduled meeting here last week, the Gates County Board of Commissioners voted to hold a public hearing on the EMS funding issue sometimes next month. The exact date is not known at this time as it is required of county officials to first notify, in writing by mail, each property owner in the county of their intentions to hold such a meeting.

During his March 18 presentation to the commissioners, County EMS Chief Stormy Butts said even with a current $410,000 appropriation from the county, the squad is operating at a deficit when it comes to meeting their actual needs.

“Based on current staffing, estimates show a $300,000 shortfall between what is appropriated and what is expected to be spent in current budget year,” Butts informed the commissioners.

He said that deficit is now being covered by the fees for service charged by Gates County EMS and collected through medical insurance of the patients for which those services are provided.

“That’s money budgeted by my board for capital improvements so we can buy the equipment we need,” Butts noted. “Right now that capital improvement fund doesn’t exist because we’re spending that money to staff our ambulances.”

He added it’s very evident at the current time, based on a growing number of calls, that the one full-time ambulance in operation – which requires four, two-person shifts (a Paramedic and an EMT) – is overwhelmed with work. That, he said, increases crew fatigue, which leads to mistakes and accidents.

Butts said if one EMS truck is tied up on a call that takes them out of the county to transport a patient, there is no back-up truck or crew on stand-by to handle another call.

Plus there are other costly plans on the horizon for all EMS entities statewide, to include a requirement by January of 2023 to have all Paramedic-level employees to hold a degree in order to gain their credentials.

“It will cost more to hire those people and retain those people in those positions,” Butts stated. “If we don’t begin making a plan today, this is going to hit us in the face two to three years down the road.”

Another costly initiative became effective last year, one that requires all newly purchased ambulances to have loading equipment. Butts said that will drive up the price of those new units by $30,000 each.

“Our minimum request for next budget year will be $130,000 more than this year and that is a band aid to get us two to three years down the road,” Butts shared with the commissioners. “I know that’s a request that the county manager cannot meet without the involvement of you guys (commissioners). I know there’s not $130,000 sitting around loose in the (county’s) General Fund.”

Last year, Butts said EMS requested a $170,000 increase from the county, and received $56,000.

He said the cost for current staffing plus adding a second, fully-staffed ambulance that would operate 24/7/365 would require an annual operating budget of $840,000.

With that in mind, Butts recommended the county study the language in North Carolina General Statute 153A-301 (establishing a tax service district). State law permits such for a wide range of items to include ambulance and rescue.

A service district adds a pre-determined tax on top of normal property taxes, with the additional assessment directly benefitting a particular entity.

“I recommend that you take a look at that statute to create a service district for the County of Gates and a service district for the municipality of Gatesville,” Butts suggested.

Butts explained the two had to be separated and that the same discussion/plan he presented to the commissioners at their March 18 meeting has to be brought before the Gatesville Town Council.

If those service districts are established, then a tax or fee will be assessed to fund EMS at an amount to add a second full-time ambulance.

Upon completing his presentation, the commissioners peppered Butts with questions.

Jonathan Jones asked about the prior use of volunteers to staff a second ambulance while Jack Owens inquired about mutual aid.

Butts said in the past, volunteers were used to help out with staffing needs, but there are none left today. He added there is mutual aid backup with EMS entities in adjacent counties, but that only adds to the response time.

“Plus there’s the fact that all of the EMS departments around us are staffed just as tightly as we are,” Butts stressed.

“Our citizens deserve having someone to respond quickly when they dial 9-1-1,” stressed Jones.

Butts added that a typical mutual aid agreement means that the responding EMS agency would send out their own bill to the insurance provider for their service plus send a bill for $100 to the county for which they are providing the service.

“That works both ways,” Butts remarked.

There was another question from Jones regarding the collection rates through the billing cycle. Butts responded by saying those losses vary by funding source….Medicaid can be as high as 30 percent.

“Across the board we average collecting right around 80 percent of what is billed,” Butts said.

Henry Jordan inquired of a percentage of calls that local EMS crews are unable to answer for lack of manpower. Butts answered that “call drops” average about one or two per week.

“We can see that you put a lot of thought into this (presentation) and also suggested a solution,” stated Commission Chairwoman Linda Hofler. “I agree that when our citizens need help they want someone to show up. We need to look at this and see what we can do.”

County Manager Natalie Rountree informed the commissioners that if a decision was reached to move forward with establishing a tax service district to help fund EMS, there are certain requirements, to include scheduling a public hearing.

“I’ve left a message at the (North Carolina) School of Government to clarify a few other items,” Rountree said. “I do know that the Town of Gatesville would have to have a special (service) district or they could approve a resolution to be included in the countywide district.”

Rountree added that if the tax service district is the answer to the EMS financial woes, all citizens (with taxable property) in the county would have to be notified in writing by mail four weeks prior to a public hearing.

“My sense of urgency tonight is that a public hearing be held at your April meeting,” Butts said.

Rountree said that timing would not work due to the four-week notification requirement. The next regularly scheduled meeting of the commissioners is Wednesday, April 3.

“The earliest a public hearing could be held would be May 1,” Rountree stated.

Owens asked if the board could hold a special called meeting in the evening where the only item on the agenda would be the public hearing on the suggested EMS tax service district.

“That would be your prerogative,” Rountree answered.

Further discussion focused on holding a special called meeting as well as following the required timeline to properly notify the public as to the date of that meeting. Jordan made a motion to hold it as early as the state statutes allow, perhaps before the end of April.

The board was in agreement and supported Jordan’s motion.