MILTON-FREEWATER — Milton-Freewater voters may face a difficult decision in November over the city’s emergency medical services.

Board members for the Milton-Freewater Ambulance Service Area Health District met with the Umatilla County Board of Commissioners on June 26 to discuss the formation of a new ambulance district due to insufficient funding.

The proposed ambulance district, which would encompass the city of Milton-Freewater like its predecessor, would be put on the ballot to raise the permanent tax rate from 25 cents per $1,000 of assessed value to a higher, yet undecided rate.

“The only way we can survive, in our opinion, is to receive more funding,” said George White, the ambulance board’s treasurer.

The process of getting the measure to the ballot hit a lull after the board wasn’t able to present it at July’s city council meeting.

“We won’t really know the status until next month,” said Dan Kilmer, the ambulance board’s president.

Until the ambulance board receives approval from the Milton-Freewater City Council, they can’t move forward in getting the proposal to the ballot.

At its current rate, the ambulance district doesn’t collect enough funds and is supplemented by the Milton-Freewater Rural Fire District.

Rick Saager is the district fire chief and privately owns Milton-Freewater Emergency Medical Service, which provides the district’s ambulances and service. Kilmer said Saager has had to shift funds to cover operational costs but has told the board he can’t for much longer due to a litany of issues.

For starters, the permanent tax rate in the area is lower than other districts yet receives more calls. White said that with $923,000 in funds for the Milton-Freewater EMS, there were 1,045 call responses last year.

That comes down to approximately $883 per response.

In nearby Athena, where its emergency services had $441,000 in funding, White said there were 210 call responses. That equates to roughly $2,100 per response.

The emergency medical service employees are also underpaid compared to neighboring districts, and Saager told the board he wants to see their wages brought closer to their counterparts.

In addition, many people who need ambulance rides struggle to pay the bill for it. Kilmer said the government’s cuts to reimbursement through Medicare and Medicaid have only compounded the problem by placing a larger financial burden on those riding in the ambulance.

The ambulances and equipment also need to be maintained and must be replaced every so many years. Purchasing a new ambulance can cost in the area of a $250,000 White said.

Saager did not return calls for comment.

Funding for emergency services has been an ongoing battle in Milton-Freewater.

The ambulance district was originally voted on and established in November 2011 with more than 86 percent of the vote, and the expectation was the district would raise $130,000 annually.

Prior to the establishment of the district, Saager and Milton-Freewater EMS served the area since 1984 after the fire district developed a quick-response team. By 2000, their services expanded to transporting Advanced Life Support patients.

But insufficient funding in 2011 caused Saager and the EMS to almost suspend services and kindled the discussions of forming an ambulance district. After a series of negotiations, the county helped keep the services running throughout the end of the year until the district could decide on a future provider.

After the district passed, the board opted to keep the area’s services with Saager. Then being subsidized by local property taxes, Saager and the Milton-Freewater EMS still struggled financially.

Kilmer has been a board member for the Milton-Freewater Ambulance Service Area Health District for roughly six years and said it’s been known for several years the funding was insufficient. Previous attempts to remedy it by applying for grants have failed or fell short of the district’s needs.

“I told them in their inception, ‘Be careful what you ask for because this is a permanent rate,’” said Paul Chalmers, Umatilla County tax assessor.

Eight years later, the board is seeking to dissolve its district and again must ask voters to raise the taxing rate.

“The question for them is how will it impact other districts,” Chalmers said.

The challenge is the constraints of compression from raising the rate. With the state’s cap on collection and spending for local government services at $10 per $1,000, the increase will ultimately impact other services.

The difficult decision for voters will be determining how much value the district’s emergency services has while balancing this potential impact.

“It becomes a political question as to whether or not folks want to vote into that,” Chalmers said.

The proposed district would require the voters to pass three measures. First, to dissolve the current district. Second, to establish the new district. And last, to determine the new tax rate. If either measure doesn’t pass, the current district would remain as is.

But failing to pass a new district would mean the potential end to the city’s ambulance service.

When local emergency services were nearly suspended in 2011, the city was going to turn to the East Umatilla County Ambulance Area Health District (Medic 400), which has services based out of Athena, and the Walla Walla City Emergency Services for help. The city of Pendleton also offered to extend its services if needed.

While these options don’t leave Milton-Freewater unaccounted for, they could double or triple wait and travel times. Ultimately, the board would have to mull over these and other options if the measures don’t make it to the ballot or don’t pass when they do.

Either way, Milton-Freewater’s emergency services can’t sustain itself as is.

“I just want [the voters] to understand we’re at a crucial moment,” White said. “We might not survive another year.”

The district’s fight for survival is emblematic of a nationwide problem plaguing rural communities.

A 2018 National Rural Health Association policy brief stated roughly one-third of rural EMS are in “immediate operational jeopardy” due to lack of funding, staffing, and reimbursement.

For those residing in Milton-Freewater and other rural areas, this makes the issue of survival quite literal.

The same NRHA report said rural Americans face 50% greater risk of trauma-related death as a result of limited emergency services and the longer wait and travel times associated with it. In America, one of the most common causes of trauma-related deaths are drug overdoses, and thus the rising opioid crisis exacerbates these risks.

While many EMS providers target a response time of eight minutes or less for Advanced Life Support patients, the NRHA report found rural communities face an average of 20-30% longer response times. Specifically in the case of opioid overdoses, this added average of 9.4 minutes per call is often the difference between life and death, according to the report.

“Unfortunately, these problems are not unique to Milton-Freewater,” county commissioner John Shafer said.

Shafer served on the Medic 400 board when its service area also faced funding issues and had to establish a new district that raised its rate to $1 per $1,000 in 2016.

For now, the next steps lie with the district board placing its future in the voter’s hands.

“It’s important that we get it onto the ballot,” county commissioner George Murdock said.

The Milton-Freewater Ambulance Service Area Health District plans to present its proposal for approval at the city council meeting on Aug. 12, which will take place at 7 p.m. inside the Albee room at the library.

The Umatilla County Board of Commissioners also will hold a public hearing Friday, July 26, where the new district’s proposed boundaries will be confirmed. Then, a second hearing where the commissioners can officially refer the issue to the ballot will be held on Aug. 16.