Every property owner in Pinellas County pays the same tax rate for emergency medical services. But when the county doles out that tax money to the 18 fire districts, the distribution is far from equal.
At the low end, county taxpayers shell out $369,564 a year for a paramedic position (enough staffing and equipment to fund one position around the clock) in St. Pete Beach. But that same position in St. Petersburg costs $541,080 — a difference of almost $172,000.
It has little to do with the size of the departments: Clearwater has among the lowest per-position costs, while Lealman is second highest.
In theory, a paramedic is a paramedic is a paramedic, especially in Pinellas, where all are held to the same standards and receive the same training. Take a paramedic, pluck him or her out of a seat in St. Pete Beach and into a seat in Tarpon Springs and there should be no effect on care.
So why the wide variations in costs?
Labor accounts for about 80 percent of the overall costs. The county's formula for each position includes 3.4 paramedics (one for each of the three 24-hour shifts and for the paramedic who replaces those who are ill or on vacation), plus support personnel, fuel, money for rescue vehicles and other such necessities. Each city and district has a different pay, benefit and pension plan. An even deeper reason is the system itself, which was set up with the cost variations. Over the years, those differences have been magnified.
"That is a design flaw from back in the '80s when this system was initially being set up," Largo fire Chief Mike Wallace said. "You are at the mercy of labor costs in each municipality."
But why should a taxpayer in St. Pete Beach, where the cost is low, have to provide money to cities and districts that have higher costs — especially when property values are dropping and the county is considering raising the EMS tax rate?
A turning point in 1978
Changing the system won't be easy, given its history.
Before the mid to late 1980s, Pinellas County was a patchwork of fire and EMS services. Some departments had professional firefighters. Others were volunteer. Some cities had medical directors. Others provided EMS funding but kept the service strictly within city limits.
"Everyone had their own little piece of the pie," Seminole fire Chief Dan Graves said.
The system seemed to work until 1978, when 16-year-old Ronnie Redwine was hit by a car as he darted across Park Boulevard on his way to a skateboard track. The accident happened just outside the Pinellas Park city limits.
A Pinellas Park EMS vehicle left the station but was called back. Two private ambulance companies were called, but neither was available. A third emergency service finally answered. Ronnie died an hour later, still lying in the road.
The public outcry prompted the creation of the current system. The county collected an EMS tax and distributed it to cities and fire districts, which agreed to come to the aid of the injured and ill no matter where they were. The goal was equal service, but there was no idea of equalizing costs.
Cities and districts would continue to pay for fire service out of their own property taxes, but they'd give up the money for EMS that they'd been collecting.
To entice cities into the system, the county asked each how big a hole the changeover would put in their budget, county Commissioner Neil Brickfield said.
"Then we plugged those holes," Brickfield said. "The yearly escalator has taken over since then."
The county soon realized that many of the cities were using the county's EMS money to subsidize fire departments, Graves said. The county moved to control costs; St. Petersburg sued. The county countersued. The court ordered the county to pay St. Petersburg at the actual cost.
"We gave up our autonomy. We shouldn't have to give up the benefits" the city offered, St. Petersburg fire Chief James Large said. "Why have an EMS tax if you're not going to pay for the system?"
Hard choices, no easy answers
Now, in the face of rampant budget deficits, the county is looking everywhere for ways to cut costs.
If, for example, the county funded all districts at the rate of the lowest cost — St. Pete Beach's $369,564 per position — the savings for countywide taxpayers would be impressive: about $5.9 million a year, a chunk of the overall $37.7 million EMS budget.
Then again, St. Petersburg alone would receive about $3.8 million less a year for its 22 positions.
If that cut is too draconian, the county could simply hold the top six providers to the average cost of $438,712 per position and save about $2.5 million a year. If the city or district wanted to put more into its EMS, it could go to its own taxpayers for the money.
"I very much sympathize with the taxpayer," Wallace said, but he warned that cutting funding too much could result in one or more departments withdrawing from the system.
Brickfield, the county commissioner, agreed that the county needs to take a hard look at the system.
"If we were setting it up today, we would have a much different system," Brickfield said. "As I've said many times, it's an imperfect system set up by imperfect people, but it does work. When you call 911, someone (comes)."
Last year, the County Commission set standards for service that could eventually be used as a basis to establish costs. It cut budget requests.
And it eliminated two paramedic positions from the Pinellas Suncoast Fire and Rescue District and gave all the EMS service in the area to a nearby Seminole station, which provides the service at a lower cost. County EMS officials are considering doing something similar this year by shifting one or more positions from Lealman to Pinellas Park now that the latter has a station in Kenneth City. The savings to the county would be about $101,000 per position.
Other possibilities include raising the EMS tax rate and using savings.
The county has also hired a consultant to study the EMS system. The consultant's recommendations are tentatively due in July.
But the solution won't be easy. Large, for example, says looking at the per-position costs of paramedics is "too simplistic." Clearwater fire Chief Jamie Geer agrees, saying it's hard to tell anything really valuable from those numbers without knowing more about the individual costs. Geer also said it's impossible to compare the expenses of a one-station department with larger entities.
Compounding the search for a solution are the high stakes — people's lives. Fire and county officials agree that it's easy to say "whack the costs" when some unknown person's life is at risk. But if someone you love is having a heart attack, no amount of money is too much to spend.
"It really boils down to level of service. Are you willing to compromise the level of service to save money?" Large asked. "It comes back to what do the residents want and what do they want to pay for?"
Anne Lindberg can be reached at firstname.lastname@example.org or (727) 893-8450.
|Funding per paramedic position|
|Lealman for Tierra Verde||$461,148|
|Largo for Belleair Bluffs||$378,188|
|St. Pete Beach||$369,564|
This chart shows the wide variations in the money cities and fire districts receive from Pinellas to fund one paramedic position for countywide EMS protection. Not only are there variations among departments, but some of the agencies charge different rates — presumably for the same level of paramedics — depending on whom they are serving. Lealman, for example, charges the county $470,989 for a paramedic position for its residents, but $9,841 less for paramedics it bases in Tierra Verde.