We asked Cosumnes Fire Department Fire Chief Tracey Hansen some questions on the first responder fee.
Question on the fee. Before treating someone, is the person informed there may be a fee? I can see where there could be some confusion if a person on the scene is offered medical care and doesn’t realize it’s a charge. Also is the fee charged to every person that is helped? For example an accident and there are 5 people and all are looked at, are all 5 assessed a fee?
Answer: Our crews do not make the billing information the focus of their responsibilities at the scene of an emergency. Their sole focus is assessing and treating any patients they encounter at scene and mitigating any hazards found. The fee is allowed by state law (CA Health and Safety Code 13910-13916) and was instituted to recover the costs of providing advanced life support services on our engines and truck in our jurisdiction. Those critical service delivery costs are not covered by property taxes. Similarly, we charge a fee for transporting patients in our ambulances. These fees are intended to provide cost recovery only, not profit. When the fee was being considered, we completed considerable public outreach. In fact, we put together a committee representing those in our community that might be most likely to use our medical services. We went “on the road” presenting to Elk Grove and Galt Chambers. I met with the residents at local assisted living facility. We put on a meeting at the Senior Center in Elk Grove. We shared our consideration for the fee with the local newspapers. During those meetings we shared the all the information about the proposed fee with everyone we met with, and that we were considering adopting the fee to address the costs of providing the advanced life support services. This amount of outreach when considering a fee n not typical for most public agencies, but the CSD has a long history of doing considerable public outreach in may of these types of things. During the time we were considering the fee, our agency was suffering deep cuts in property tax revenues due to the recession. We had a rotating engine company closure nearly everyday which was significantly effecting our response times to emergencies in the affected response area. We saw this as an opportunity to cost recover for those services easing the burden on the General Fund thereby allowing us to reinstate the daily staffing on the engine company that was closed. As you know, we were able to eliminate that engine company closure months ago in part due to the relief felt by this revenue source.
The fee amount was developed by an independent consultant hired to objectively look at the costs for the service. They took the typical time a first responder engine or truck is at scene of a medical aid from our historical records, which turned out to be 20 minutes. They considered the costs of personnel on the engine, the wear and tear on the apparatus themselves, etc. for that 20 minute window in coming to a number to recover costs. At the time of the fee implementation that was $143, but may be adjusted each fiscal year based on Medical CPI, so it has gone up slightly today at $147 . Our fee application is also unique in that we prorate the fee based on the number of patients and the number of units that respond and are directly assigned patient care at an incident. For example, when we respond to a structure fire there are many engines and trucks at scene. Let’s say at that structure fire we treat a patient. The fee would be charged based solely on the engine and/or truck companies who participate in assessing and treating the patient, not the total number of resources as scene fighting the fire. If the medic unit at scene handles the medical need and no engine or truck company personnel assist, there is no First Responder Fee applied. If the engine or truck company are cancelled before arrival at a scene the fee is not applied. If the person we contact is not a “patient” as described by state law and county protocol, there is no bill applied. The fee is triggered by the patient care record generated we gain the details about whether or not the incident qualifies for application of the fee based on the fields filled out by our paramedics at scene.
This fee is increasingly common across the state; it is not unique to our agency. I can say that our fee is lower than any other fee of this nature in the state that I am aware of. This is based on the deep dive our consultant did in ensuring that it was based on cost recovery only and developed in as friendly a way as possible, at our direction. The fee is also unique to each agency based on their respective cost of providing these services. The fee must be billed to all qualifying patients equally. We cannot pick and choose who gets the bill. If the fee is determined in an appeal to not be in the “public interest”, under the law the board can waive it. This waiver request must go to the board or the board must delegate that authority to staff members for carrying out. Since the fee was intended to be temporary and the Board wanted to maintain a high level of awareness on the fee program, they wanted these appeals to come to them. When a patient requests a waiver they simply need to send me something in writing. A simple one sentence e-mail can be enough. If the patient wishes to offer me additional details as to the justification for waiving the fee, I bring those to the board as well. The balance of the work on the appeal is handled by staff. When staff prepare the staff report for the board, the patient may review it ahead of time to ensure it captures their “side” of the story and includes all the facts. The patient may come to the board meeting when the item is to be heard if they desire, but it is not necessary. Some have criticized us for not having this good Samaritan example in our Ordinance so we could have waived the fee automatically, but as you might imagine there any number of circumstances that may create a need to consider a waiver. That list would be impossible to predict. As a result, we just included the language for the appeal process and staff would do all the legwork, should a patient wish to appeal for a waiver.
In Mr. DeAnda’s case, we applaud his stopping and intervening to assist that family in their time of need. We would never discourage that action when it is safe for the good Samaritan to do so. Mr. DeAnda was not billed because he was a good Samaritan, because he accessed 911, or because he was offered a bottle of water.
Because Mr. DeAnda was injured, he qualified as a “patient”. Our personnel are required by state law and county protocol to assess anyone at scene with an injury (no matter how minor), offer treatment and transport, and document that interaction. That was what was done here with Mr. DeAnda. That patient care report documentation triggered the fee be processed by our billing contractor. The billing contractor should have prorated the fee for Mr. DeAnda in accordance with our fee program as described above, but failed to do so. That was quickly corrected. His fee under this program is actually $29; however, in reality, the issue at hand here is not the amount of the fee at all, it is about billing “Good Samaritans”. I get that, and we are trying to make it right through this board-adopted ordinance we MUST follow. We communicated that information to Mr. DeAnda previously, but never received his request. We have, based on his public comments regarding his intent to appeal, initiated that appeal on his behalf. We will bring that item for the Board’s consideration at the first meeting in July.
I know this is a VERY lengthy response, but I feel compelled to offer you a detailed answer to put this whole scenario into context. Only part of the information we offered in our interviews with the Sacramento CBS affiliate were offered, which have understandably infuriated people. I also recognize that fees are not popular in the first place, so no matter what the justification, some will not be satisfied.
Again, we deeply value Mr. DeAnda actions that day. We are doing our part to assist in addressing this fee application and seeking the board’s approval for waiver on his behalf. We sincerely hope to eliminate the fee for all patients in the very near future. We are committed to ensuring this fee is temporary.
If you need any follow up, please don’t hesitate to contact me.