Billing, training woes force Millinocket to shelve Howland ambulance service plans [Bangor Daily News, Maine]

June 15--MILLINOCKET, Maine -- Poor planning and management practices in two area fire departments that included a lack of malpractice insurance and improperly coded billing invoices prompted town leaders to shelve a proposal to provide ambulance service to Howland, officials said Friday.

The Town Council voted 5-0 on Thursday to table indefinitely the proposal, with councilors opting to agree with Town Manager Peggy Daigle that the Howland and Millinocket fire departments just weren't ready yet, council Chairman John Davis said.

"She raised some concerns there. She talked with [Millinocket Fire Chief Andrew Turcotte] about it, and I believe they were both in agreement on it," Davis said Friday. "Listening to Andy it sounds like there might be [revenue generated by the service] but we have to do some things to straighten out our own house first."

The council's decision leaves Howland leaders working to ensure that residents of the south Lincoln Lakes region have ambulance service by July 1, Howland Town Manager Tracey Hutton said.

The Howland Board of Selectmen voted 5-0 about a month ago to accept an ambulance donated by Penobscot Valley Hospital of Lincoln and commitments from Maxfield, Passadumkeag, Seboeis and possibly Enfield to use the Howland-based ambulance instead of the Lincoln-East Millinocket ambulance service based in Lincoln, Hutton said.

"The selectmen were aware that the town manager in Millinocket had some issues with the service," Hutton said Friday. "They have been looking at alternatives such as applying to Maine Emergency Management Services for their own services in Howland."

"So we are still looking to move forward and plan for an ambulance service, but until the selectmen make a decision, I can't predict what they will do," Hutton added. "We have been telling the public that we are working hard to have a service in place by June 30."

Penobscot Valley Hospital has agreed to transfer its ambulance service to East Millinocket and Lincoln fire departments on that date at 6 p.m. Those town departments will then cover most of the area handled by the hospital under an agreement Lincoln officials announced this week.

Howland might seek to join Lincoln's service, but Hutton said she doubted that would happen.

Turcotte and Howland Fire Chief Phil Dawson had been in discussions regarding creating the service for several months after Hutton protested to Lincoln's council that East Millinocket and Lincoln officials had apparently not posted an ambulance to Howland, as Howland officials wished. Dawson resigned from the Lincoln Fire Department as chief last month, with Dawson denying a conflict of interest in handling the negotiations.

"I would never say never," Hutton said of working with Lincoln's ambulance service, "but that's not our intent."

Turcotte and Daigle did not return messages left Thursday and Friday. Dawson did not return a message left on Friday.

Turcotte and Daigle are newcomers to Millinocket. Turcotte began work in September 2012, replacing Chief Wayne Campbell, who retired June 30 after 42 years on the job. Daigle began work in April, succeeding Eugene Conlogue, who became Houlton's town manager in October.

Millinocket essentially replaced its front-line vehicle fleet with a new pumper truck and a used pumper in April, after several years of declining town budgets -- and what Turcotte has described as no "well-defined maintenance and capital outlay program" -- left the department with a 40-year-old pumper- and a 31-year-old ladder truck with a faulty pump.

Daigle told councilors in a memo dated June 3 that she liked the concept of Millinocket firefighters providing ambulance coverage to Howland, which is about 40 miles south of Millinocket, but didn't think either department was ready.

"Millinocket is just getting the Ambulance Department reorganized and still has some ongoing operational issues," Daigle wrote.

The department needs more firefighters at paramedic or advanced life service levels. Most firefighters are EMTs or intermediates, she wrote. Training costs are also an issue, as is replacing firefighters in training with staff getting paid overtime.

Billing problems include incorrectly coded and inadequately-detailed invoices and a lack of council approval for amounts written off accounts, Daigle wrote. About 20 percent of approved charges "are not actively pursued," she wrote.

Daigle's memo also lists $450,000 in needed capital expenses on ambulances, and a need for town government oversight for new hires and purchases. Millinocket must also tighten its relationships with Millinocket Regional Hospital and the East Millinocket Fire Department to ensure success with the ambulance program and with handling emergencies, Daigle wrote.

Daigle listed 12 flaws she found in Howland's operations or plans, including a lack of adequate cash flow, no billing mechanism at Millinocket Regional Hospital or malpractice insurance, plus undeveloped contracts and many problems arising from having Millinocket hire firefighters to work in Howland.

Millinocket firefighters handle 700 to 800 emergency calls annually with 100 ambulance transfers. Howland's workload "is estimated conservatively" at 300 emergency calls and 100 transfers with a budgeted revenue of $160,000 to $200,000 annually, Daigle wrote.

A "conservative" estimate of the Howland ambulance service's start-up costs is $166,940, Daigle wrote.

Millinocket has budgeted revenue for annual emergency and transfer calls at $386,993 with operating expenses of $472,435, Daigle wrote.

"At this point in time, I am not convinced that this is in the best interest of Millinocket to expand services to Howland," Daigle wrote. "It is more important for the town to refine and improve its internal operations for Millinocket before expanding outside the town boundaries."

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