The BulleTin • Sunday, april 25, 2021 A5
Ambulance
dict medical professionals. The
next court hearing is May 6,
according to court records.
“This is an isolated situa-
tion,” Bill Boos, Oregon Fire
Chief Association second vice
president. “This isn’t some-
thing that other fire depart-
ments or districts are doing in
Oregon. It won’t affect anyone
else.”
In some areas, the am-
bulance service can bill the
patient the balance after an
insurer pays, but in communi-
ties with a high percentage of
Medicaid patients, the federal
program pays anywhere from
27% to 67% of the bill and the
fire district or department has
to accept that payment as paid
in full.
The La Pine fire district,
which has two ambulances,
oversees a 117 square-mile area
for fire protection services and
1,000 square miles for the am-
bulance service district, Hub-
bard said in an email.
The district’s policy states a
fee will be imposed directly to
the medical facility, health care
facility, medical office, medical
clinic or hospital for all ambu-
lance transports for patients
from their facility to another.
The fire chief has the discre-
tion to interpret and apply the
policy, according to the dis-
trict’s policy.
Oregon law divides the state
into ambulance service areas
that are bid on and overseen by
counties. In Deschutes County,
the ambulance service area
plan oversees the award of the
contract to a district or de-
partment. Also under Oregon
law, a patient can refuse to be
transported by ambulance to
an emergency department. It’s
a protection offered under the
law for patients who don’t have
medical insurance coverage
and would be responsible for
the ambulance fee.
Because it’s a 30-minute
drive along U.S. Highway 97 to
get to St. Charles Bend’s emer-
gency department, many folks
in La Pine and the surrounding
communities like Chemault
and Christmas Valley buy in-
surance to cover the cost of air-
lifting or ambulance services,
said Gawith who has lived in
La Pine for 40 years.
Having access to medical
care is important, Richer said,
the La Pine mayor.
In 2020, St. Charles’s La Pine
clinic called 911 95 times re-
questing transport from its
clinic to the hospital in Bend.
In 2020, the La Pine Commu-
nity Health Center called 911
on behalf of patients 35 times,
according to Hubbard’s email.
“Emergency medical service
is an expense,” Hubbard said in
an email. “Due to the high vol-
ume of ambulance transports
to St. Charles ER (1,046 in
2020) the district ambulances
are replaced every 2 1/2 to 3
years costing $250,000 each.
The 2021 operating budget
cannot afford to add additional
firefighter/paramedics.”
Letters of testimony
But since 2020, the fees have
been adding up against the two
health centers and caused a
controversy in the community
that brought out more than
50 letters of testimony for and
against the ordinance at a Janu-
ary public hearing.
“I need you to know I highly
disagree with the actions that
this (policy) has enlisted,”
Anita Clark wrote in her testi-
mony. “I think that a doctor is
the one to determine if emer-
gency transportation is needed.
I do not think that they would
call for our services if they did
not think that it was absolutely
necessary.”
Another who testified was
Robin Lannan Adams, a re-
tired internal medicine phy-
sician, who also launched a
campaign for a seat on the fire
district board.
“I first learned of this con-
flict between the ambulance
and the medical clinics last
year,” Lannan Adams said in
an interview recently. “I started
attending the fire board meet-
ings to get educated, and I was
shocked by the decisions made.
Patients need ambulance trans-
port. They’re not going by am-
bulance because they need a
ride.”
La Pine residents Mark and
Colleen Donzelli said in an
email that their experience in
the medical field in San Fran-
sisco supports the fire district.
“We understand about the
frequent flyer and the urgent
care doctor not wanting to be
sued so he passes the buck to
the 911 service,” said Colleen
Donzelli in her written testi-
mony.
“This county has grown and
the county planners have not
planned for this issue.”
The Oregon Health Author-
ity oversees and approves am-
bulance services and licenses
ambulance agencies and ve-
hicles, but it does not regulate
billing practices, said Jona-
than Modie, a health authority
spokesman.
In 2020, the district trans-
ported 1,046 patients to St.
Charles Bend’s emergency de-
bor Day wildfires that burned
400,000 acres of land, de-
stroyed more than 700 homes
and killed five people.
While Central Oregon
avoided the direct impacts of
the flames, smoke from the fires
in Western Oregon drifted over
the mountains, creating a pall of
unhealthy air that lasted a week.
The dry fuels this year are a rec-
ipe for another big fire incident.
Larry O’Neill, director of Ore-
gon Climate Services at Oregon
State University in Corvallis,
said the dry conditions are a dis-
appointment for some climatol-
ogists, who were expecting more
precipitation from the La Nina
effect this winter.
“La Nina didn’t really ma-
terialize, consequently much
of the state is in at least severe
drought,” said O’Neill. “We are
already witnessing impacts on
agriculture and wildfire risk
that we usually do not see until
July or August.”
Parts of Klamath and Lake
counties to the south of Bend
are in exceptional drought for
the first time since the U.S.
Drought Monitor started in
2000. The tri-counties (De-
schutes, Crook, and Jefferson)
of Central Oregon are a mix of
moderate, severe and extreme
drought.
Central Oregon is also be-
hind in snowpack, which does
not bode well for sufficient
late-season runoff that can
help cool vegetation and for-
ests. The snowpack is 84% of
normal and water year-to-date
precipitation is just 83% of
normal, as of Friday.
Scott Oviatt, the snow sur-
vey supervisor for Natural Re-
sources Conservation Service
Oregon, says snowmelt is in-
creasing because of unseason-
ably warm temperatures over
the past week. High tempera-
tures hovered at 60 degrees but
hit 80 on April 18.
“Snow is melting out more
rapidly than melt rates ob-
served over the last several
years,” said Oviatt. “This will
lead to less surface water and
upper level soil moisture being
available in the early summer
for use in irrigation and less
available for forest vegetation.”
Central Oregon has already
seen increased levels of fire in
2021. The Oregon Department
of Forestry has responded to
eight fires in the tri-counties this
year, compared to an average of
two fires for this time of year.
The Bull Springs Fire, which
consumed 211 acres after a
strong windstorm March 28, has
been the largest blaze to date in
Central Oregon this year. Stock
said that wildfire was the result
of dry fuels, high winds and low
live fuel moisture levels.
Other parts of Oregon
and Washington state have
also seen early fire activity.
The Ponina Fire in Klamath
County was first reported on
April 17 and grew to 1,641
acres before full containment.
The wild card, of course, is
Continued from A1
“The ordinance (billing
practice) is not in the commu-
nity’s best interest at all,” said
La Pine Mayor Dan Richer. “It’s
being driven by money.”
The city of 2,343 people
doesn’t have any jurisdiction
over this issue, Richer said. The
La Pine Rural Fire Protection
District is governed by its own
board, which passed the or-
dinance allowing the unusual
billing practice in 2019.
The central issue is that
the fire district provides am-
bulance service at a loss, said
Jerry Hubbard, a fire district
board member whose term
expires in June, in an email re-
sponse. As a way to cover the
costs, the board of directors at
the fire district approved an or-
dinance in 2019 that gave the
fire chief approval to impose
an ambulance transport fee
and a non-emergency medical
fee on 911 calls he deemed not
life-threatening.
The policy was changed
earlier this month by the fire
district board to now charge
health facilities for all ambu-
lance transport, regardless of
the reason.
Suit filed
The fire district’s actions
prompted the La Pine Com-
munity Health Center and St.
Charles Family Care Clinic
in La Pine to file a lawsuit
last year disputing more than
$350,000 in combined 911 ini-
tiated ambulance fees charged
by the district to the clinics.
The two La Pine medical fa-
cilities allege the fire district’s
fee structure is illegal because
it shifts the burden of payment
from the patient that received
the service to the entity that
made the 911 call. The lawsuit
also alleges the policy gives
the fire district the authority
to determine if an ambulance
ride was medically necessary,
an action that could contra-
Wildfires
Continued from A1
Fire officials categorize fuels
by size and how long it takes
atmospheric moisture to im-
pact two-thirds of its material.
Trees and brush can be 1,000-
hour fuels while small fuels
such as leaves and grass, fall
into the 10-hour fuels category.
The 1,000-hour fuel mois-
ture level, one of the main
instruments scientists use to
determine how dry a forest
has become, was down to 15%
on Friday when the average
for this time of year is around
20%. Just a month ago the
moisture level was 25%. The
higher the percentage, the less
likely there is a chance of ex-
treme fire behavior.
Fuel moisture level, mea-
sured with electronic equip-
ment, indicates how a wildfire
will behave in a certain area.
When available fuels are moist
the combustion slows down,
causing fires to burn most
slowly and with less intensity.
The opposite occurs when
available fuels are dry.
The indexes used by fire offi-
cials to gauge moisture levels are
well below average, said Boone
Zimmerlee, who is responsi-
ble for facilitating the growth
of a fire-adapted community
strategy in Deschutes County
through management of a wild-
fire preparedness program.
“Continued drying trends
are likely to persist if we don’t
get moisture,” Zimmerlee said.
The Energy Release Com-
ponent index, which is related
to how hot a wildfire can burn,
shows that Central Oregon
reached approximately 50 on
Friday, double the average level
for this time of year.
The dry conditions come as
Western Oregon is still clean-
ing up from devastating La-
Ryan Brennecke/The Bulletin file
Medics from La Pine Rural Fire Protection District wheel a patient into the St. Charles Bend emergency room
in 2011.
patio
world
partment, according to Hub-
bard.
They are transported not
just from clinics, but from
homes and doctors’ offices.
Typically Medicare pays a
flat fee for emergency and
non-emergency ambulance
services when the patient’s
medical condition is bad
enough that any other method
would endanger their health.
“The district has a policy
that it will never leave the cit-
izens of La Pine without fire,
emergency medical service and
rescue services,” said Hubbard
in an email. “Many times both
ambulances are taking patients
to St. Charles ER or returning
to the district.”
The district’s practice con-
cerns Oliver Tatom, a regis-
tered nurse supervisor at St.
Charles Family Care and In-
termediate Care in La Pine.
Tatom, a former paramedic in
Jefferson County, said he fears
he is not getting the right care
for his patients.
“I worry that if a patient is
having a heart attack or stroke,
I don’t want them driving or
being driven to a clinic or to an
emergency department,” Ta-
tom said. “Patients with chest
pains or difficulty breathing
should activate 911 from their
home or business for transport
by ambulance under the care
of a paramedic.
“Every minute counts with
a heart attack,” he said. “You
don’t want people getting in
their car to drive to an emer-
gency department in the midst
of a medical emergency.”
Last year, the clinic saw
more than 7,000 patients
and referred about 700 to the
emergency department at St.
Charles. Only 95 of them went
by ambulance from the clinic,
Tatom said.
“It’s a big safety issue, and
it does impact patient safety,”
Lannan Adams said.
precipitation. Rain is expected
in Central Oregon over the
weekend but it may not be
enough to soak fuels for long.
If May and June see increased
rains, it could help to reduce
the dry conditions from build-
ing in the region.
“How fire season goes is de-
pendent on the amount and
timing of rain,” said Stock. “If
we keep getting this dry pat-
tern, you know, we will defi-
nitely be in high fire danger
really early.”
e e
e e
Reporter: 541-633-2117,
sroig@bendbulletin.com
Reporter: 541-617-7818,
mkohn@bendbulletin.com
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